MEDICARE: SPLASH FOR SPEECH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP13700	CA

General Provider Information

NPI Number	:	1972977213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPLASH FOR SPEECH, INC.

Provider Business Mailing Address
First Line	:	3637 MOTOR AVENUE
Second Line	:	SUITE 280
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4884
Country	:	US
Telephone Number	:	310-876-1110
Fax Number	:	310-876-1114

Provider Business Practice Location Address
First Line	:	3637 MOTOR AVENUE
Second Line	:	SUITE 280
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4884
Country	:	US
Telephone Number	:	310-876-1110
Fax Number	:	310-876-1114

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. AMY WILHELM
Credential	:	M.S. CCC-SLP
Telephone Number	:	310-876-1110

Provider Enumeration Date	:	11/24/2015
Last Update Date	:	11/24/2015

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Directions to “SPLASH FOR SPEECH, INC. ” Practice Location

Language	Start Address	Practice Location

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